Provider Demographics
NPI:1437825528
Name:HALDEMAN, ELIZABETH ANGELA (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANGELA
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 WOODHOLLOW DR APT 206
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3956
Mailing Address - Country:US
Mailing Address - Phone:763-313-4343
Mailing Address - Fax:
Practice Address - Street 1:4941 BENCHMARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:763-313-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist